Relapse Prevention PMC

These strategies also focus on enhancing the client’s awareness of cognitive, emotional, and behavioral reactions in order to prevent a lapse from escalating into a relapse. The first step in this process is to teach clients the RP model and to give them a “big picture” view of the relapse process. For example, the therapist can use the metaphor of behavior change as a journey that includes both easy and difficult stretches of highway and for which various “road signs” (e.g., “warning signals”) are available to provide guidance. According to this metaphor, learning to anticipate and plan for high-risk situations during recovery from alcoholism is equivalent to having a good road map, a well-equipped tool box, a full tank of gas, and a spare tire in good condition for the journey. Further, analyses revealed several drinking goal × CBI interactions such that the benefit of cognitive behavioral intervention over medical management was not supported for participants whose reported goal was complete abstinence.

Drinking Goals in Alcoholism Treatment

This success can then motivate the client’s effort to change his or her pattern of alcohol use and increase the client’s confidence that he or she will be able to successfully master the skills needed to change. Marlatt and Gordon (1985) have proposed that the covert antecedent most strongly related to relapse risk involves the degree of balance in the person’s life between perceived external demands (i.e., “shoulds”) and internally fulfilling or enjoyable activities (i.e., “wants”). A person whose life is full of demands may experience a constant sense of stress, which not only can generate negative emotional states, thereby creating high-risk situations, but also enhances the person’s desire for pleasure and his or her rationalization that indulgence is justified (“I owe myself a drink”). In the absence of other non-drinking pleasurable activities, the person may view drinking as the only means of obtaining pleasure or escaping pain. If you view your lapse as a mistake and as a product of external triggers, rather than as a personal failure, research shows that you will have a much better chance of return to abstinence quickly.

Outcome Studies for Relapse Prevention

Asking clients questions designed to assess expectancies for both immediate and delayed consequences of drinking versus not drinking (i.e., using a decision matrix) (see table, p. 157) often can be useful in both eliciting and modifying expectancies. With such a matrix, the client can juxtapose his or her own list of the delayed negative consequences with the expected positive effects. The AVE was introduced into the substance abuse literature within the context of the “relapse process” (Marlatt & Gordon, 1985, p. 37). Relapse has been variously defined, depending on theoretical orientation, treatment goals, cultural context, and target substance (Miller, 1996; White, 2007). It is, however, most commonly used to refer to a resumption of substance-use behavior after a period of abstinence from substances (Miller, 1996).

Relapse prevention, recovery management, recovery transcendence

Recent reviews provide a convincing rationale for the putative role of implicit processes in addictive behaviors and relapse [54,56,57]. Implicit measures of alcohol-related cognitions can discriminate among light and heavy drinkers [58] and predict drinking above and beyond explicit measures [59]. One study found that smokers’ attentional bias to tobacco cues predicted early lapses during a quit attempt, but this relationship was not evident among people receiving nicotine replacement therapy, who showed reduced attention to cues [60].

• Editor’s Choice articles are based on recommendations by the scientific editors of MDPI journals from around the world.Editors select a small number of articles recently published in the journal that they believe will be particularlyinteresting to readers, or important in the respective research area.
• Broadly speaking, there are at least three primary contexts in which genetic variation could influence liability for relapse during or following treatment.
• That said, a recent meta-analysis by Tonigan (Tonigan et al., 2018) found consistent abstinence benefits from participation in AA by those dually diagnosed.
• This suggests that individuals with non-abstinence goals are retained as well as, if not better than, those working toward abstinence, though additional research is needed to confirm these results and examine the effect of goal-matching on retention.

1. Nonabstinence treatment effectiveness

While attesting to the influence and durability of the RP model, the tendency to subsume RP within various treatment modalities can also complicate efforts to systematically evaluate intervention effects across studies (e.g., [21]). The most promising pharmacogenetic evidence in alcohol interventions concerns the OPRM1 A118G polymorphism as a moderator of clinical response to naltrexone (NTX). An initial retrospective analysis of NTX trials found that OPRM1 influenced treatment response, such that individuals with the Asp40 variant (G allele) receiving NTX had a longer time until the first heavy drinking day and were half as likely to relapse compared to those homozygous for the Asn40 variant (A allele) [92]. This finding was later extended in the COMBINE study, such that G carriers showed a greater proportion of days abstinent and a lower proportion of heavy drinking days compared in response to NTX versus placebo, whereas participants homozygous for the A allele did not show a significant medication response [93]. Moreover, 87.1% of G allele carriers who received NTX were classified as having a good clinical outcome at study endpoint, versus 54.5% of Asn40 homozygotes who received NTX.

Global Clinical Outcome

All rights are reserved, including those for text and data mining, AI training, and similar technologies. Rather than labeling oneself as a failure, weak, or a loser, recognizing the effort and progress made before the lapse can provide a more balanced perspective. For Jim and Taylor, this might involve acknowledging the months of sobriety and healthier lifestyle choices and understanding that a single incident does not erase that progress. abstinence violation effect In a study of NHS workers, Day and colleagues (Day et al., 2005) found that clinicians were highly confident they understand what happens at AA meetings but had never actually visited one. To the extent that such attitudes emerge from a perception that AA is ineffective, we hope the Cochrane Review will prompt a re-evaluation and in turn a greater willingness to help AUD patients test out this remarkable fellowship for themselves.

Stopping a Slip From Becoming a Relapse

Analysis accommodated the clustering of observations by site through the estimation of a random intercept term. A key contribution of the reformulated relapse model is to highlight the need for non-traditional assessment and analytic approaches to better understand relapse. Most studies of relapse rely on statistical methods that assume continuous linear relationships, but these methods may be inadequate for studying a behavior characterized by discontinuity and abrupt changes [33]. Consistent with the tenets of the reformulated RP model, several studies suggest advantages of nonlinear statistical approaches for studying relapse. Another factor that may occur is the Problem of Immediate Gratification where the client settles for shorter positive outcomes and does not consider larger long term adverse consequences when they lapse.

• Furthermore, in that study the majority of relapse episodes after treatment occurred during situations involving negative emotional states, a finding that has been replicated in other studies (Cooney et al. 1997; McKay 1999; Shiffman 1992).
• Other critiques include that nonlinear dynamic systems approaches are not readily applicable to clinical interventions [124], and that the theory and statistical methods underlying these approaches are esoteric for many researchers and clinicians [14].
• The desire for immediate gratification can take many forms, and some people may experience it as a craving or urge to use alcohol.

Self-control and coping responses

This approach is exemplified by the “urge surfing” technique [115], whereby clients are taught to view urges as analogous to an ocean wave that rises, crests, and diminishes. Rather than being overwhelmed by the wave, the goal is to “surf” its crest, attending to thoughts and sensations as the urge peaks and subsides. The current review highlights multiple important directions for future research related to nonabstinence SUD treatment. For example, despite being widely cited as a primary rationale for nonabstinence treatment, the extent to which offering nonabstinence options increases treatment utilization (or retention) is unknown. In addition to evaluating nonabstinence treatments specifically, researchers could help move the field forward by increased attention to nonabstinence goals more broadly. For example, all studies with SUD populations could include brief questionnaires assessing short-and long-term substance use goals, and treatment researchers could report the extent to which nonabstinence goals are honored or permitted in their study interventions and contexts, regardless of treatment type.

Historical context of nonabstinence approaches

In addition to the primary outcome variables of the COMBINE study, post hoc analysis of drinks per drinking day revealed that patients with a goal of controlled drinking reported fewer drinks per drinking day while those oriented towards complete abstinence as a goal reported greater drinks per drinking day. These findings were conceptualized in the context of the abstinence violation effect, whereby an initial lapse triggers heavier within-episode drinking among abstinence-oriented individuals (Marlatt & Gordon, 1985). McCrady [37] conducted a comprehensive review of 62 alcohol treatment outcome studies comprising 13 psychosocial approaches. Two approaches–RP and brief intervention–qualified as empirically validated treatments based on established criteria. Interestingly, Miller and Wilbourne’s [21] review of clinical trials, which evaluated the efficacy of 46 different alcohol treatments, ranked “relapse prevention” as 35th out of 46 treatments based on methodological quality and treatment effect sizes.